Provider Demographics
NPI:1104877299
Name:WALDMANN, TODD M (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:WALDMANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2855 E MAGIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6245
Mailing Address - Country:US
Mailing Address - Phone:208-639-4900
Mailing Address - Fax:208-639-4901
Practice Address - Street 1:2855 E MAGIC VIEW DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6245
Practice Address - Country:US
Practice Address - Phone:208-639-4900
Practice Address - Fax:208-639-4901
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-7595208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010004760OtherBLUE SHIELD BOISE
ID805249200Medicaid
ID76711OtherBLUE CROSS MERIDIAN
IDB4893OtherBLUE CROSS BOISE
ID000010157306OtherBLUE SHIELD MERIDIAN
IDP00250287OtherRAILROAD MEDICARE
ID000010157306OtherBLUE SHIELD MERIDIAN
ID76711OtherBLUE CROSS MERIDIAN